Fig. 4
From: Prostate MRI based on PI-RADS version 2: how we review and report
Clinical Notes: Actual PSA: 27.5 ng/ml; PSA last year: 31.4 ng/ml. One year previous prostate biopsy revealed no cancer.
Technical Details: Standard prostate MRI protocol, 3 T MRI scanner, 16 ml Multihance.
Findings: Enlarged prostate of circa 43 ml (44 mm × 51 mm × 37 mm × 0.52). Peripheral zone: Midlevel on T2w image depicts a focal lesion of 20 mm maximal extension (PI-RADS 5) (white arrows). The lesion shows a high signal intensity in the anterior fibromuscular stroma and in the left peripheral anterior zone on the high b-value DW image (white arrowheads) with corresponding low signal intensity on the ADC map (black arrowheads) (ADC ~580 × 10−6mm2/s) (PI-RADS 5). DCE-MRI is rated positive, showing a focal enhancement, earlier than adjacent prostate tissue (black arrows). Transition zone: Circumscribed hypointense encapsulated nodules (BPH) (PI-RADS 2). No suspicious locoregional or pelvic lymph nodes. No suspicious bone lesions. No additional findings.
Conclusion: Clinically significant prostate cancer is highly likely to be present in the anterior fibromuscular stroma and in the left peripheral anterior zone in the midlevel with greatest dimension ≥ 1.5 cm corresponding to PI-RADS 5. No suspicious lymph nodes or bone lesions.
Histology: MRI-TRUS fusion guided biopsy revealed Gleason score 4 + 3 = 7